SURGERY. 207 
The apparatus necessary for TYING AN ARTERY is much like that required 
im operations for aneurism: a straight edged scalpel (fig. 5), a Bromfield 
tenaculum artery forceps, aneurismal needle, &c. The artery is to be 
elevated by a tenaculum or forceps at or near the spot where the ligature 
is to be applied, and this passed beneath or over the artery to be severed 
and tied by an assistant (pl. 139, jig. 8, a, the vessel held by the surgeon 
with the forceps, 0, the thread, d, d, passed round, and the knot tied by the 
assistant). 
Sometimes a vessel is tied by simply passing a thread round it, without 
laying it bare, the extremities of the thread being then tied tightly together. 
Pi. 189, fig. 2, a, the bleeding vessel; 0, ¢, points where the needle is first 
passed in and out; d, e, points where this is done a second time. 
The method of torsion consists in twisting the extremity of the severed 
vessel several times round with sliding forceps (pl. 140, figs. 35, 36, 37). 
Pi. 189, fig. 4, is intended to show the usual points of incision either in 
tying wounded arteries, or in performing operations on aneurism: a 0, inci- 
sion for laying bare the supericr thyroid artery, which begins near the 
angle of the lower jaw, over the submaxillary gland, and descends an inch 
and a half to the lower border of the thyroid cartilage; ¢ d, incision for 
exposing the carotid artery.. This, two and a half inches long, passes along 
the inner border of the sterno-cleido-mastoid; ef Zang’s incision for the 
same purpose as the last. It descends from the top of the cricoid cartilage, 
between the two portions of the sterno-cleido-mastoid on its outer margin, 
and ends one quarter of an inch above the clavicle; g A, Zang’s incision 
for exposing the subclavian artery above the clavicle. It commences two 
inches above the clavicle, on the posterior margin of the sternal extremity 
of the sterno-cleido-mastoid, and passes obliquely downwards and outwards 
to the middle of the upper margin of the clavicle; 7 4, Hodgson’s incision 
for the same purpose as the last, along the upper margin of the clavicle, to 
the point of attachment of the trapezius to the clavicle; /m, incision for 
-exposing the subclavian along the inner margin of the scalenus anticus 
_ immediately over the sternal end of the clavicle, three inches long; 
no, incision for exposing the subclavian beneath the clavicle; g 7, Rust 
and Zang’s incision for the same purpose; s ¢, Lisfranc’s incision for expos- 
ing the axillary artery in the axilla; wv, incision for the brachial artery in 
the middle of the arm; w 4, incision in the left arm for the same purpose, 
a little ngher up; yz, incision for the same purpose in the bend of the 
elbow; ”*, incision for the radial artery along the upper portion of the 
forearm ; **, the radial artery over the carpus; *°, the ulnar artery in the 
superior portion of the forearm; ”’, ulnar artery over. the carpus; * ”, inci- 
sion for the descending artery according to Cooper; *’’, internal iliac after 
Stevens; **"*, do. after Abernethy and Scarpa; , do. after Cooper ; 
» 8 for exposing the crural artery below the groin;  “’, do. in the middle 
of the thigh ; *””, the posterior tibial artery along the upper third of the leg 
after Marjolin; * *, do. in the middle of the leg, after Lisfranc; * ®, do. 
behind the inner ankle; ****, incision-for the anterior tibial in the middle 
ofthe leg; °°, do. in the lower part of the leg. | 
ICONOGRAPHIC ENCYCLOPZDIA.—VOL, II. 58 918 
15, 36 
